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In crisis: Why are police apprehending more mentally ill people?

Toronto police are apprehending more people than ever before and taking them to hospital under mental health legislation, according to data obtained exclusively by the Star.

Mental Health Act apprehensions in the city have skyrocketed over the past two decades — from 520 in 1997 to 8,441 in 2013, raising questions about community services for people with mental illness.

Advocates say changes in the legislation and chronic funding problems in the mental health system are prompting increased encounters between police and people with mental illness, which can end in tragedy.

“I absolutely think that the underfunding has led to police seeing more people with mental health problems and crises than they ought to,” said Dr. Vicky Stergiopoulos, psychiatrist-in-chief at St. Michael’s Hospital.

Michael Eligon was shot and killed by police on February 3, 2012

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“I think it’s a direct reflection not only of the underfunding, because you can throw a lot of money at a system that’s broken and it’s not going to fix it. I think we need a complete redesign of services.”

Ontario’s Mental Health Act allows police to take people to hospital if they pose a risk to themselves or to others, or are unable to care for themselves.

The provincial act was last updated in 2000, with the controversial Brian’s Law, named for sportscaster Brian Smith, who was killed by a man suffering severe mental illness.

The law expanded police powers and responsibilities in a number of ways.

For one, police are no longer required to observe the person’s disturbed behaviour firsthand.

It also created “community treatment orders,” which compel people to take medication or face being apprehended by police and taken back to hospital.

Anita Szigeti, a lawyer with the Empowerment Council, an advocacy group representing people who have accessed psychiatric services, said the impetus for Brian’s Law was to intervene sooner, when a person’s mental state first starts to deteriorate. But no new in-patient psychiatric beds have been added.

“Who’s not in that bed is the person who wants to be admitted, who knows they’ve decompensated, who is feeling like they’re going to hurt themselves or hurt someone else,” Szigeti said. “Those people can’t get a bed, because all the beds are taken up by people who don’t want to be there,” and who in fact may pose no risk to anyone, she said.

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Szigeti said community treatment orders were supposed to be reserved for the most chronically unwell people, about 250 across the province. Now, there are at least 5,000 of those orders imposed on people who don’t necessarily need them and who would be compliant with medical orders anyway, she said.

“I don’t know what, if anything, the legislation has done to help. All it’s really done is exponentially increase contact with the police, and people are getting shot and killed,” she said.

Some advocates say the rising number of Mental Health Act apprehensions may be a good sign: where officers may have previously arrested people suffering from an emotional crisis and taken them to jail, perhaps now they are better trained to recognize the signs of a mental illness and are taking those people to hospital instead.

Barry Swadron, a civil rights lawyer who wrote the 1967 Mental Health Act, and who represented the family of Jeffrey Munro, a mentally ill man killed by another inmate while housed in the psychiatric unit of the Don Jail, said he was encouraged by the statistics, to a certain extent.

“If (people with mental illness) are acting in a disorderly manner, you can be sure that there’s some crime they could be charged with. But to take them directly to a psychiatric facility where they’re going to be examined is a far more humane approach,” he said.

Ontario’s mental health funding has declined since the 1970s, from 11.3 per cent of health care funding to 7 per cent. This is less than the national average of 7.2 per cent, and significantly less than the target of 9 per cent recommended by the Mental Health Commission of Canada in its national strategy on mental health in 2012.

Some high-income countries, including the U.K. and Sweden, invest more than 10 per cent of their health budget on mental health services, wrote Steve Lurie, executive director of the Canadian Mental Health Association’s Toronto branch, in a recent report.

“A lack of funding is actually a structural representation of stigma. It’s the ‘out of sight, out of mind’ phenomenon. This isn’t a big enough priority,” Lurie said in an interview.

Advocates say that community mental health services are crucial to keeping people out of hospital. These services include, for example, the Gerstein Centre in Toronto, which offers supportive counselling, telephone support, community visits and a ten-bed, short-stay residence.

But currently, these kinds of services are often difficult to reach, plagued by long wait lists and chronic under-funding. Further, there is a dire need for supportive housing and more employment services, said Stergiopoulos.

“You can provide all the care you want, if somebody is homeless, it’s not going to help them very much,” she said. “If you look at who the frequent users are of services, a lot of them are poor, experience social disadvantage and housing instability. We need to look at all the contributors to this.”

David Jensen, spokesperson for the Ministry of Health and Long-Term Care, said the province released a 10-year mental health and addictions strategy in 2011.The first three years of the strategy focused on children and youth, with funding of $93 million. An additional $65 million was proposed in the 2014 budget.

The province also doubled spending on community mental health over the past decade, from $399 million in 2003 to $810 million in 2013, said Jensen. (This still represents a small fraction of overall increased health spending.)

Deputy Chief Michael Federico, a 40-year veteran of the Toronto police, has taken leadership of the mental health file. He said police were experiencing a rising number of calls about what they term “emotionally disturbed persons” — about 20,000 such calls in 2011.

Federico said there is more awareness of mental health disorders in society and thus more people are seeking help for themselves or loved ones. But many calls to police would be better responded to by community agencies or mental health professionals, he said.

“I’m not going to tell people, ‘Don’t call police,’ ” he said. “But if it’s a situation where a person is struggling and feeling more anxious and looking for a re-introduction into a stream of care, that would be much better handled (by) somebody other than the police.”

He called it a “truism” that the best way to prevent lethal encounters between police and people with mental illness is to avoid those interactions in the first place.

“Sadly, we will be called where a situation is now out of control. When we look back upon the individual’s history, we can easily identify intervention points. The problem is, does the community have the capacity to intervene at that point?” he asked.

A recent inquest into the police shooting deaths of three mentally ill people — Michael Eligon, 29; Reyal Jardine-Douglas, 25; and Sylvia Klibingaitis, 52, recommended, among other things, that police stop automatically handcuffing people taken into custody under the Mental Health Act. Advocates say handcuffing people shames them and makes them feel like criminals.

When asked about this recommendation, however, Federico said that officers only handcuff people when necessary. This came as a surprise to Jennifer Chambers, director of the Empowerment Council.

“That’s not what they’re telling clients,” she said. “Clients say, ‘The police told me they have to handcuff everybody.’ . . . I haven’t heard of anyone who’s not been handcuffed. Perhaps I haven’t met them.”

She said she was concerned by the increasing number of involuntary hospitalizations under the Mental Health Act.

“The answer to people being distraught is not institutionalizing them. There’s so much evidence to show that isn’t necessary. Instead, you need to start with social determinants of health and good community supports.”

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